How to reconstruct the lordosis of cervical spine in patients with Hirayama disease? A finite element analysis of biomechanical changes focusing on adjacent segments after anterior cervical discectomy and fusion

Lu, Xiao; Zou, Fei; Lu, Feizhou; Ma, Xin; Xia, Xinlei; Jiang, Jianyuan

doi:10.1186/s13018-022-02984-y

Cited by 8 publications

(7 citation statements)

References 38 publications

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“…RoM is an indicator of spinal stability. If the segment stability is good after interbody fusion, the RoM is small [ 32 ]. On the contrary, if the RoM is large, the stability of fusion segment and adjacent segments after TLIF is poor.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration: a 3D finite element study

Wang

et al. 2022

J Orthop Surg Res

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Objective To investigate the biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration undergoing transforaminal lumbar interbody fusion (TLIF) surgery, so as to provide references for selection of interbody cage. Methods The finite element model of normal lower lumbar spine (L3–S1) was built and validated, then constructed three different degenerative segments in L3–L4, and the cages with different height (8, 10, 12, 14 mm) were implanted into L4–L5 disc. All the twelve models were loaded with pure moment of 7.5 N m to produce flexion, extension, lateral bending and axial rotation motions on lumbar spine, and the effects of cage height on range of motion (RoM) and intervertebral pressure in lumbar spine were investigated. Results The RoM of adjacent segments and the maximum stress of intervertebral discs increased with the increase in cage height, but this trend was not obvious in mild and moderate degeneration groups. After implantation of four different height cages (8, 10, 12, 14 mm), the RoM of L3/L4 segment reached the maximum during extension. The RoM of mild degeneration group was 2.07°, 2.45°, 2.48°, 2.54°, that of moderate degeneration group was 1.79°, 1.97°, 2.05°, 2.05°, and that of severe degeneration group was 1.43°, 1.66°, 1.74°, 1.74°. The stress of L3–L4 intervertebral disc reached the maximum during flexion. The maximum stress of L3–L4 intervertebral disc was 20.16 MPa, 20.28 MPa, 20.31 MPa and 20.33 MPa in the mild group, 20.58 MPa, 20.66 MPa, 20.71 MPa and 20.75 MPa in the moderate group, and 21.27 MPa, 21.40 MPa, 21.50 MPa and 21.60 MPa in the severe group. Conclusion For patients with mild-to-moderate lumbar degenerative disease who need to undergo TLIF surgery, it is recommended that the height of fusion cage should not exceed the original intervertebral space height by 2 mm, while for patients with severe degeneration, a fusion cage close to the original intervertebral height should be selected as far as possible, and the intervertebral space should not be overstretched.

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Section: Discussionmentioning

confidence: 99%

Biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration: a 3D finite element study

Wang

et al. 2022

J Orthop Surg Res

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“…Follower loads of 75 N were used to simulate muscle force and head weight. A 1.0-N/m moment and 75-N follower load were applied to the odontoid of the C2 vertebrae to produce flexion, extension, lateral bending, and axial rotation ( Rong et al, 2017 ; Wu et al, 2019 ; Wo et al, 2021 ; Lu et al, 2022 ). The ALL, PLL, nucleus pulposus, and annulus fibrosus were resected at C5/6, while the bilateral structures, such as uncinate processes, were preserved according to real surgical procedures.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Zhang

Yang²,

Shen³

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.

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“…40 Finite element modeling predicts that factors predisposing to adjacent segment disease are minimized if cervical lordosis is maintained in patients with HD, underscoring the importance of considering correction of spinal deformity when surgery is indicated. 45 In summary, HD is uncommon and often self-limited. For severe or refractory cases of HD, guidelines for surgical management have been developed, with a variety of approaches deemed efficacious.…”

Section: Lessonsmentioning

confidence: 99%

Surgical management of Hirayama disease in a pediatric patient presenting with severe cervical kyphosis and focal myelopathy: illustrative case

Kurland

Neifert

Khan

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Hirayama disease (HD) is a rare, nonfamilial neuromuscular disease causing cervical myelopathy and deformity, most commonly effecting pubertal Asian males. Patients whose nonoperative treatment fails and who cannot tolerate long-term cervical immobilization, experience relapse after arrest of symptoms, or present with severe features warrant surgical treatment. Here, the authors present an unusual case of HD that resulted in rapid progression of severe cervical kyphosis and discuss surgical management strategies. OBSERVATIONS A 15-year-old male presented with unprovoked neck pain, progressive chin-on-chest phenomenon, and cervical myelopathy. Imaging revealed a severe subaxial cervical kyphosis of 88° and severe spinal cord compression secondary to changes within the thecal sac, ligaments, and bony elements. He underwent a multistage surgery involving halo gravity traction, C3–6 anterior cervical discectomy and fusion, and C2 to T2 posterior instrumented fusion with C3–5 Smith-Petersen osteotomies. Cervical subaxial pedicle screws facilitated deformity correction through a cantilever technique. LESSONS HD is rare and often self-limited. For severe or refractory cases of HD, guidelines for surgical management have been suggested, with a variety of approaches deemed efficacious. This is the first case of a patient presenting with such severe cervical deformity; early diagnosis and recognition is the first step toward prompt, adequate management.

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How to reconstruct the lordosis of cervical spine in patients with Hirayama disease? A finite element analysis of biomechanical changes focusing on adjacent segments after anterior cervical discectomy and fusion

Cited by 8 publications

References 38 publications

Biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration: a 3D finite element study

Biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration: a 3D finite element study

Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis

Surgical management of Hirayama disease in a pediatric patient presenting with severe cervical kyphosis and focal myelopathy: illustrative case

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